BMJ 2014;348:g1436 doi: 10.1136/bmj.g1436 (Published 12 February 2014)
Page 1 of 1
Letters
LETTERS MEDICALISING UNHAPPINESS
Evidence suggests massive overdiagnosis and, by extrapolation, overprescription of antidepressants Richard Braithwaite consultant psychiatrist Isle of Wight NHS Trust, St Mary’s Hospital, Newport, Isle of Wight PO30 5TG, UK
Reid and colleagues dismiss Godlee’s claims of antidepressant overuse,1 2 yet the evidence they quote does not support their view.
Rather, Mitchell and colleagues’ meta-analysis showed that, for every 10 patients correctly diagnosed with depressive disorder in primary care, 15 are wrongly diagnosed with the disease.3 So, in this sample of 50 000, only two fifths of patients diagnosed by general practitioners were unwell. This is clear evidence of overdiagnosis. It cannot prove overprescription, but it surely lends support to, rather than disproves, Godlee’s thesis.
As a psychiatrist, anecdotal evidence of widespread overprescription surrounds me. Sadly, many specialists in the field are as indiscriminate diagnosticians as the future generalists they are responsible for training. I have witnessed consultants
asking patients whether they feel “depressed” then basing a diagnosis and prescription on the answer. This sloppy practice would be indefensible in other specialties: would an endocrinologist prescribe insulin because a patient feels “diabetic”? Competing interests: None declared. 1 2 3
Reid I, Cameron I, MacGillivray S. Increased prescription of antidepressants shows correction of inadequate duration of treatment of depression. BMJ 2014;348:g228. (21 January.) Godlee F. Don’t keep taking the tablets [Editor’s Choice]. BMJ 2013;347:f7438. (11 December.) Mitchell AJ, Vaze A, Rao S. Clinical diagnosis of depression in primary care: a meta-analysis. Lancet 2009;374:589-99.
Cite this as: BMJ 2014;348:g1436 © BMJ Publishing Group Ltd 2014
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Letters
LETTERS MEDICALISING UNHAPPINESS
Evidence suggests massive overdiagnosis and, by extrapolation, overprescription of antidepressants Richard Braithwaite consultant psychiatrist Isle of Wight NHS Trust, St Mary’s Hospital, Newport, Isle of Wight PO30 5TG, UK
Reid and colleagues dismiss Godlee’s claims of antidepressant overuse,1 2 yet the evidence they quote does not support their view.
Rather, Mitchell and colleagues’ meta-analysis showed that, for every 10 patients correctly diagnosed with depressive disorder in primary care, 15 are wrongly diagnosed with the disease.3 So, in this sample of 50 000, only two fifths of patients diagnosed by general practitioners were unwell. This is clear evidence of overdiagnosis. It cannot prove overprescription, but it surely lends support to, rather than disproves, Godlee’s thesis.
As a psychiatrist, anecdotal evidence of widespread overprescription surrounds me. Sadly, many specialists in the field are as indiscriminate diagnosticians as the future generalists they are responsible for training. I have witnessed consultants
asking patients whether they feel “depressed” then basing a diagnosis and prescription on the answer. This sloppy practice would be indefensible in other specialties: would an endocrinologist prescribe insulin because a patient feels “diabetic”? Competing interests: None declared. 1 2 3
Reid I, Cameron I, MacGillivray S. Increased prescription of antidepressants shows correction of inadequate duration of treatment of depression. BMJ 2014;348:g228. (21 January.) Godlee F. Don’t keep taking the tablets [Editor’s Choice]. BMJ 2013;347:f7438. (11 December.) Mitchell AJ, Vaze A, Rao S. Clinical diagnosis of depression in primary care: a meta-analysis. Lancet 2009;374:589-99.
Cite this as: BMJ 2014;348:g1436 © BMJ Publishing Group Ltd 2014
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
